Managing Deep Sternal Wound Infections With Vacuum‐assisted Closure

Abstract

Deep sternal wound infection is an uncommon but serious complication of cardiac surgery. Currently, there is no consensus on the optimal management. Vacuum-assisted closure (VAC) has been increasingly used to facilitate wound healing. We aim to review the management of deep sternal wound infections using VAC dressing at our hospital. A retrospective review of consecutive cases of deep sternal wound infections was carried out. Median sternotomies were carried out in 2665 patients between July 2001 and June 2006. Thirty-one patients developed deep sternal wound infections (1.2%). In 26 of these patients, VAC dressing was used either as a stand-alone therapy or as an adjunct to late sternal reconstruction. Deep sternal wound infections were diagnosed on average 13 days from initial surgery. Of the patients treated with VAC dressing, 17 (65%) had stand-alone VAC therapy and 9 had VAC therapy followed by sternal reconstruction. The average duration of VAC dressing in the two groups were 21 and 13 days respectively. There were seven in-hospital deaths, six in the stand-alone VAC group and one death from a reconstructive patient who did not have VAC therapy. The length of hospital stay was similar in two VAC groups (37 vs 45 days). Median follow up was 17 months. No late relapse was found in the stand-alone group. In the intermediate therapy group, two patients had chronic wound sinuses and one patient had a wound collection. Vacuum-assisted closure dressing may be used both as a stand-alone and as an intermediate therapy for deep sternal wound infection. Reconstructive surgery may be avoided in a significant proportion of patients. No late relapse has been associated with VAC use.

Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation in posttraumatic osteomyelitis

“…Our present findings confirm and extend these findings by showing that NPT results in a higher percentage healed wounds and a lower recurrence rate of infection in posttraumatic osteomyelitis, thus precluding the need for multiple surgical interventions and likely even (multiple) amputations. [14][15][16] The assumed working mechanisms of NPT are diminishment of interstitial edema, increase of capillary blood flow, and significant decrease of bacterial growth inside the wound. [17][18][19][20][21][22] Furthermore, during NPT growth of granulation tissue into the wound is observed as a response to the mechanical force of suction.…”

Post-sternotomy mediastinitis in the modern era

“…It is a Class IIa recommendation by the AATS that NPWT should be initiated whenever possible in patients in whom delayed sternal closure is anticipated following DSWI . Vacuum‐assisted closure has been shown to increase peristernal blood flow by increasing arteriolar dilatation, reduce bacterial load, promote granulation tissue formation, and facilitate approximation of sternal wound edges . Several studies report excellent outcomes with the use of VAC in DSWI.…”

Assessment of vacuum‐assisted closure therapy on the wound healing process in cardiac surgery

“…Wound healing outcomes are also improved through an enhanced angiogenesis process that aids formation of granulation tissue leading to a reduction in the lengths of hospital stays. This has consequently reduced the costs of patient care and has led to an improvement of quality of life (6,(11)(12)(13)(14).…”

“…Postoperative deep sternal wound infection (DSWI) is a serious complication in cardiac surgery affecting 1-5% of patients with high morbidity and mortality rates ranging from 5% to 46% (1)(2)(3)(4)(5). This is also one of the most common complications in open-heart surgery along with heart failure and stroke (6). DSWI as documented by the US Centers for Disease Control is: 'Infection involving fascia or deeper with at least one of the following: evidence of infection seen at re-operation or spontaneous dehiscence, positive culture of mediastinal fluid and/or positive blood culture and/or chest pain with sternal instability and temperature higher than 38 degrees Celsius' (2,7).…”